When we start to screen and ask about alcohol use as well as misuse of medications, it’s much larger than we ever imagined.

Bartels says that’s happening for a couple of reasons. For one thing, older people tolerate less alcohol as they age. And people are living longer. And with age come pain and ailments and attempts to manage them.

In instances where people are taking more than prescribed or in ways that are not as prescribed that we’re seeing significant patterns of abuse in that area. But alcohol is the real problem for older adults, and much more so than any other drug.

Bartels says the majority of chronic middle-aged drinkers are men.

But among those who develop addictions to alcohol later in life:

Two-thirds of those people tend to be women, interestingly enough. And it tends to be associated with multiple losses, losing a spouse or having more physical impairments or loss of social support.

And they can go for years before realizing their drinking interferes with their daily living.

Bonnie Houle is in her late 60s. She lives alone in an apartment in Merrimack with her cats.

I was working. I was doing my job. I was doing it well. I was doing everything I needed to do on the outside. I worked at my church.

She’s an alcoholic in recovery.

I did most of my drinking right here with the cats. As long as I fed them and took care of their litter box, they didn’t object to my drinking.

Houle says she was barely a social drinker most of her adult life.

And for much of it, she lived with her mother.

She had two children who were alcoholics and I wasn’t about to be the third one. Which is probably what prevented me from over drinking for many years. I was 51 when she died.

After losing her mom, Houle moved to a housing complex with lots of opportunities to meet other people.

We would gather at night on patios having wine. That’s when it started to rise. It got to be a little more and a little more and eventually I was drinking wine in the morning before going to work. And I loved my wine. And I won’t say I loved every glass I drank because when it became a serious problem I didn’t want to drink and I couldn’t’ stop. There was a period of months when I didn’t enjoy any drink and it was just what I had to do.

Twice a friend or a neighbor called an ambulance when they found Houle passed out on the floor. And twice Houle admitted herself to an in-patient treatment facility.

That second time was two years ago. Houle’s been sober since.

Like Houle, Canadian author Ann Dowsett Johnston’s alcoholism began later in life.

Johnston – who in her memoir Drink, researches the gender gap in risky drinking — opened up about her own battles with alcoholism at a New Hampshire event last fall.

In my 50s I hit empty nest syndrome. I was numbing depression with alcohol. I went from drinking one or two glasses a night to three or four or five and I began to black out.

Johnston claims that for the baby boom generation, alcohol is the professional women’s steroid. It’s legal. It’s accessible.

We know all about trans fats and all about tanning beds. But we tend to think that red wine is like dark chocolate. Good for us. Not true. Unlike tobacco, we’re not educated. Men get into trouble, but women get into trouble far faster. We die typically 20 years earlier typically than a tobacco-related death.

Johnston writes in her book that women would sooner identify as a depressed person than as an alcoholic.

And that women, especially those over 50, fear the stigma.

That’s particularly true for adults in their 70s and 80s says Stephen Bartels of the Dartmouth Center for Aging:

The kind of pull yourself up by the boot strap perspective, the greatest generation that is supposed to be self-reliant, there’s a sense that alcohol or drug problems or mental health problems are a sign of weakness. They feel a great deal of shame about accepting treatment. They don’t even want to be seen in a waiting room.

And the problem could grow worse in the coming years.

The New Hampshire Center for Public Policy projects that by 2030, nearly half a million Granite Staters will be over the age of 65, almost one-third of the population.

Bartels says one response to this so-called silver tsunami is to get primary care doctors, home healthcare workers, and even family members to intervene now, for example, by regularly asking questions about a patient’s drinking habits.

Because like many illnesses, early screenings lead to better outcomes.